Nasal Septal Hematoma: An Overview

Introduction

An accumulation of blood in the septum (the area in the nose between the two nostrils) is called a nasal septal hematoma. Hematomas resemble bruises or blood clots but can cause tissue damage and infection if left untreated. Even though they are uncommon, nose trauma can result in nasal septal hematomas. Even though it may seem insignificant, it is important to comprehend its causes, symptoms, diagnosis, and course of treatment to act quickly and avoid consequences.

What Is Nasal Septal Hematoma?

A nasal septal hematoma is a build-up of blood inside the nasal septum, the thin bone and cartilage wall that separates the nasal cavity into the two nostrils. The most common cause of this illness is trauma to the nose, such as a direct hit or injury, which destroys the blood vessels in the septum and causes bleeding and hematoma (accumulation of blood outside the blood vessel) formation. A septal hematoma can result in pain, swelling, congestion in the nose, and possibly even more serious issues if treatment is not received.

How Common Is Nasal Septal Hematoma?

A septal hematoma is an uncommon condition affecting people of any age. It is yet unknown how frequently septal hematomas occur. Nonetheless, reports indicate that 0.8 percent to 1.6 percent of patients with nasal injuries who enter ear, nose, and throat clinics experience it. Unfortunately, many cases, especially in children, frequently go untreated until problems arise.

What Are the Causes of Nasal Septal Hematoma?

The following are considered the most common causes of nasal septal hematoma:

Traumatic Factors:

• Sports-related injuries.

• Roadside mishaps.

• Assault falls.

• Workplace accidents.

Minor Accidents:

• Nasal septal hematomas can result from even small injuries, particularly in young patients.

Fear of Abuse Against Children:

• Particularly in infants and toddlers, a nasal septal hematoma without any injuries should arouse suspicions of child abuse.

Iatrogenic Infections:

• Complications from nasal procedures, such as turbinate (a procedure done to reduce the size of inferior nasal turbinate), endoscopic sinus (done to remove blockages in sinus), or septal repair surgery (done to fix a deviated septum).

Atraumatic Origins:

• Seldom observed in individuals with bleeding diathesis (unusual susceptibility to bleed), a propensity to bleed profusely, or as a side effect of antiplatelet/anticoagulant medications.

What Are the Consequences of Nasal Septal Hematoma?

A thin layer of cartilage with tissue adhered to it makes up the anterior portion of the nasal septum. It draws blood from certain arteries in the nose and is between three and four millimeters thick. All major blood arteries connect in a tiny region called the Kiesselbach plexus in the lower front portion of the septum. Blood can pool here when the nose's cartilage cracks, perhaps resulting in a hematoma on both sides.

Although the specific cause of a nasal septal hematoma is unknown, doctors believe that small blood vessels may burst as a result of cartilage damage pulling tissue away. Blood then gathers in the space between the cartilage and the outer layer. The accumulation of blood can harm cartilage by applying pressure on it.

If the damage is significant, there may be a hematoma on both sides as a result of the cartilage breaking and blood flowing to the other side. This is riskier since it can accelerate the cartilage's deterioration and put more strain on it. If left untreated, hematomas can develop an infection in as little as 72 hours. This may result in the development of a potentially fatal septal abscess, a pus-filled pocket.

What Are the Signs and Symptoms of Nasal Septal Hematoma?

Typically, the nasal septum is narrow and stiff. The doctor can use a swab to gently press down on the septal hematoma because the affected area will be pliable. Additionally, they can examine the nose to check for any swelling in the area between the nostrils.

Additional signs of a septal hematoma consist of:

• Inhaling through the nose is difficult.

• Congestion bruises a shift in the nose's general form.

People who have a septal hematoma may also occasionally experience

• Headache.

• Vomiting.

• Nausea.

• Fainting.

How to Diagnose the Nasal Septal Hematoma?

The doctor will typically use an instrument known as a nasal speculum or otoscope to inspect the nose to confirm a nasal septal hematoma. They will be searching for soft-to-the-touch, bluish, or reddish swollen areas. If any blood clots are found, they will be suctioned out. The hematoma may occasionally be felt by lightly touching the inside of the nose with a finger, even though it may not be visible.

A hematoma feels soft and puffy, unlike a deviated septum, which feels solid and curved. A hematoma's size will decrease when decongestant sprays like oxymetazoline are used. This examination usually serves as the basis for the diagnosis; however, if the diagnosis remains unclear after the physical examination, a CT (computed tomography) or MRI (magnetic resonance imaging) scan may occasionally be required.

What Are the Treatment Options for Nasal Septal Hematoma?

The doctor must treat a septal hematoma immediately to prevent other problems from developing. They must evaluate the degree of harm and choose the most effective plan of action for care. Drainage of the septal hematoma is required. To do this, two distinct methods are applied. The amount of the clot or swelling will determine which one the doctor chooses.

A tiny incision can be made to let the blood drain if the illness is being treated quickly and is still quite minor. It is critical to have the necessary equipment, including numbing medication, a flashlight, a tool for holding the nose open, and others, to drain a nasal septal hematoma. The head is slightly lifted, and the patient lies down.

A tiny needle is used to drain blood from minor hematomas. To drain the blood from larger ones, a little slit is made in the snout. Saliva is used to clean the region. The nose is sealed with gauze to stop further bleeding, and a little tube may be inserted to continue draining blood. Antibiotics are prescribed after the procedure.

The purpose of antibiotics is to stop infections. After the bleeding stops, the packing and tube are taken out a few days later. Regular examinations are necessary for patients to ensure that there are no more problems. To ensure the hematoma has been drained, the patient must be examined in the clinic within 24 to 48 hours. Inspecting the nose might be necessary to take off the packing.

What Is the Differential Diagnosis of Nasal Septal Hematoma?

• Hypertrophy of the adenoids.

• Angiofibroma (benign tumor of connective tissue).

• Persistent sinus infection.

• Chondromas (benign tumors of cartilage).

• Hemangioma teratologies.

• Polyps in the nose.

• Papillomas (benign epithelial tumor)

• Pyogenic granuloma (small, raised red bumps on the skin).

• Rhinitis.

• Abscess in the septum.

• Abnormalities of the septum.

What Are the Complications of Nasal Septal Hematoma?

One of the main consequences of a nasal septal hematoma is a nasal septal abscess. The brain and sinuses are nearby areas where the abscess might quickly expand. A saddle nose deformity may result from the increasing hematoma's ability to cause avascular necrosis of the cartilage and collapse.

Conclusion

Nasal septal hematoma is a problem that needs to be identified quickly and managed appropriately to avoid complications. It usually follows a nose injury and, if addressed, can result in breathing problems and perhaps an infection. A clinical examination is essential for a diagnosis, frequently assisted by instruments like an otoscope or nasal speculum. To achieve appropriate healing, treatment entails draining the hematoma while under local anesthesia, followed by close observation and follow-up. Most patients can anticipate positive results and prevent long-term consequences with prompt intervention and appropriate treatment.